Light at the End of the Tunnel: The Learning Curve Associated with Endoscopic Transsphenoidal Skull Base Surgery

 

 Buy Article Permissions and Reprints

ABSTRACT

Endoscopic transsphenoidal resection of skull base lesions has been introduced widely as an alternative to microscopic transmucosal approaches. We report the introduction of this technique to our unit, including the learning curve recognized for this procedure, comparing techniques in a concurrent case-control fashion. All patients operated on for sellar, suprasellar, or clival lesions were considered for endoscopic surgery, with 51 patients undergoing endoscopic surgery and 46 having microscopic surgery with the operating method determined by the availability of the ear, nose, and throat surgeon involved with the procedures. Endoscopic surgery compared favorably with microscopic surgery with respect to endocrine control, length of stay, diabetes insipidus, and cerebrospinal fluid leakage. A learning curve was found with a significant fall in complication rates between the first third and most recent third of the cohort. Endoscopic skull base surgery has superior results to microscopic approaches once the initial learning curve is overcome, but this can be done quickly and safely.

REFERENCES

• 1 Doglietto F, Prevedello D M, Jane J A, Han J, Laws E R. A brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery Neurosurg Focus 19(6):E3. 2005
  PubMedGoogle Scholar
• 2 Apuzzo M L, Heifietz M D, Weiss M H, Kurze T. Neurosurgical endoscopy using the side-viewing telescope.  J Neurosurg. 1977;  46 398-400
  CrossrefPubMedGoogle Scholar
• 3 Jankowski R, Auque J, Simon C, Marchal J C, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery.  Laryngoscope. 1992;  102 198-202
  PubMedGoogle Scholar
• 4 Jho H D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients.  J Neurosurg. 1997;  87 44-51
  CrossrefPubMedGoogle Scholar
• 5 Jho H D. Endoscopic transsphenoidal tumor surgery.  Operative Tech Neurosurg. 2002;  5 218-225
  PubMedGoogle Scholar
• 6 Cho D Y, Liau W R. Comparison of endonasal endoscopic surgery and sublabial microsurgery for prolactinomas.  Surg Neurol. 2002;  58 371-375 discussion 375-376
  CrossrefPubMedGoogle Scholar
• 7 Cappabianca P, Cavallo L M, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal approach for pituitary adenomas.  J Neurosurg. 2002;  97 293-298
  CrossrefPubMedGoogle Scholar
• 8 O'Malley Jr B W, Grady M S, Gabel B C et al.. Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve.  Neurosurg Focus. 2008;  25 E10
  PubMedGoogle Scholar
• 9 Koc K, Anik I, Ozdamar D et al.. The learning curve in endoscopic pituitary surgery and our experience.  Neurosurg Rev. 2006;  29 298-305
  CrossrefPubMedGoogle Scholar
• 10 Sonnenburg R E, White D, Ewend M G, Senior B. The learning curve in minimally invasive pituitary surgery.  Am J Rhinol. 2004;  18 259-263
  PubMedGoogle Scholar
• 11 Couldwell W T. Transsphenoidal and transcranial surgery for pituitary adenomas.  J Neurooncol. 2004;  69 237-256
  CrossrefPubMedGoogle Scholar
• 12 Charalampaki P, Reisch R, Ayad A et al.. Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases.  J Clin Neurosci. 2007;  14 410-415
  CrossrefPubMedGoogle Scholar
• 13 Yano S, Kawano T, Kudo M et al.. Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas.  Neurol Med Chir (Tokyo). 2009;  49 1-7
  CrossrefPubMedGoogle Scholar
• 14 Tabaee A, Anand V K, Barrón Y et al.. Predictors of short-term outcomes following endoscopic pituitary surgery.  Clin Neurol Neurosurg. 2009;  111 119-122
  CrossrefPubMedGoogle Scholar
• 15 Higgins T S, Courtemanche C, Karakla D et al.. Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors.  Am J Rhinol. 2008;  22 649-652
  PubMedGoogle Scholar
• 16 Neal J G, Patel S J, Kulbersh J S, Osguthorpe J D, Schlosser R J. Comparison of techniques for transsphenoidal pituitary surgery.  Am J Rhinol. 2007;  21 203-206
  CrossrefPubMedGoogle Scholar
• 17 Casler J D, Doolittle A M, Mair E A. Endoscopic surgery of the anterior skull base.  Laryngoscope. 2005;  115 16-24
  CrossrefPubMedGoogle Scholar
• 18 White D R, Sonnenburg R E, Ewend M G, Senior B A. Safety of minimally invasive pituitary surgery (MIPS) compared with a traditional approach.  Laryngoscope. 2004;  114 1945-1948
  CrossrefPubMedGoogle Scholar
• 19 Dehdashti A R, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series.  Neurosurgery. 2008;  62 1006-1015
  CrossrefPubMedGoogle Scholar
• 20 Jain A K, Gupta A K, Pathak A, Bhansali A, Bapuraj J R. Excision of pituitary adenomas: randomized comparison of surgical modalities.  Br J Neurosurg. 2007;  21 328-331
  CrossrefPubMedGoogle Scholar
• 21 Tabaee A, Anand V K, Barron Y et al.. Endoscopic pituitary surgery: a systematic review and meta-analysis.  J Neurosurg. 2009;  , E-pub ahead of print PMID 19199461
  PubMedGoogle Scholar
• 22 Jho H D, Alfieri A. Endoscopic transsphenoidal pituitary surgery: various surgical techniques and recommended steps for procedural transition.  Br J Neurosurg. 2000;  14 432-440
  CrossrefPubMedGoogle Scholar

Stuart James SmithB.A. B.M. B.Ch. F.R.C.S. 

27 Kingfisher Way, Loughborough, Leicestershire

LE11 3NF, UK

Email: sjsmith@doctors.net.uk